Surgical correction in orbitotemporal neurofibromatosis with dystopia.

BACKGROUND: Orbitotemporal neurofibromatosis is a challenging disease for orbital surgeons. Ptosis correction may be needed following correction of orbital dystopia. CASE PRESENTATION: A 34-year-old man, who underwent excision of a neurofibroma on the right eyelid in our clinic, returned to our clinic four years later complaining of dystopia and bulkiness of the protruding mass in the right eyelid and eyebrow. Computed tomographic imaging showed dysplasia and deformity in the sphenoid bone and orbit. A large mass was found in the superior portion of the orbit, protruding towards the temporal lobe, which in turn displaced the orbit downwards. A bicoronary incision and transcranial approach were performed, followed by the excision of the superior orbital space and temporal lobe mass by uncovering certain portions of the frontal, temporal, and zygomatic bones. After the excision of the mass, a calvarial bone graft was used to remodel the longitudinal widened orbit to correct the dystopia. While primary surgery was successful in the correction of dystopia, secondary surgery was performed to correct the exacerbated ptosis by levator muscle resection. CONCLUSIONS: Correction of orbitotemporal neurofibromatosis with dystopia involves three steps: removal of the mass in the orbit to eliminate the effect of downward dislocation of the orbit, placement of a bone graft in the orbit floor after repositioning the orbit for suspension and remodeling of the orbit, and following the correction of dystopia, ptosis may be corrected if needed.

Absorbable Plate-Related Infection after Facial Bone Fracture Reduction.

Absorbable plates are used widely for fixation of facial bone fractures. Compared to conventional titanium plating systems, absorbable plates have many favorable traits. They are not palpable after plate absorption, which obviates the need for plate removal. Absorbable plate-related infections are relatively uncommon at less than 5% of patients undergoing fixation of facial bone fractures. The plates are made from a mixture of poly-L-lactic acid and poly-DL-lactic acid or poly-DL-lactic acid and polyglycolic acid, and the ratio of these biodegradable polymers is used to control the longevity of the plates. Degradation rate of absorbable plate is closely related to the chance of infection. Low degradation is associated with increased accumulation of plate debris, which in turn can increase the chance of infection. Predisposing factors for absorbable plate-related infection include the presence of maxillary sinusitis, plate proximity to incision site, and use of tobacco and significant amount of alcohol. Using short screws in fixating maxillary fracture accompanied maxillary sinusitis will increase the rate of infection. Avoiding fixating plates near the incision site will also minimize infection. Close observation until complete absorption of the plate is crucial, especially those who are smokers or heavy alcoholics. The management of plate infection is varied depending on the clinical situation. Severe infections require plate removal. Wound culture and radiologic exam are essential in treatment planning.

An Additional Option for Split-Thickness Skin Graft Donors: The Previous Free Flap Sites.

Free flap reconstruction is the best choice for soft-tissue defect. However, there are often accompanying problems such as partial flap loss, donor-site skin problems, and loss of previous skin grafts surrounding the flap site. This is especially true when dealing with multiple trauma, complex defects, and large skin flaps. Because of the simplicity of the procedure involved, split-thickness skin grafts are usually used for reconstructing skin and soft-tissue defects. These are also a good choice when there is a need for further procedures because of defects from several potential causes. Pain and the loss of healthy donor tissue are major concerns in such operations. Hence, we thought that the previous skin flap area might be a good alternative area for split-thickness skin grafts accompanying procedures subsequent to free flap reconstruction. Because this donor area is no longer sensitive, local anesthesia can be used during harvesting, and there is no loss of healthy donor tissue. Therefore, this procedure is an economical means of obtaining tissue for soft-tissue reconstruction. We describe 9 examples of flap reconstruction done in this way and suggest that this is a useful option for donor site.

Usefulness of a negative suction drain for reducing postoperative swelling in a blowout fracture.

PURPOSE: To identify whether a negative suction drain is more effective than a Penrose drain in the decrease of postoperative swelling from a blowout fracture. PATIENTS AND METHODS: This was a retrospective study of patients who underwent surgical treatment for isolated orbital floor fracture. The population was categorized into 2 groups: one with a Penrose drain and the other with a negative suction drain in the surgical site. To evaluate the degree of swelling, the interlid length was measured. The predictor variable was the type of drain used. The outcome variable was the interlid length at postoperative days 1, 3, 5, and 7. The other study variables were patient characteristics, type of injury, time from injury to surgery, and operative duration. Bivariate, multivariate, and Pearson correlation analyses were used to assess the relation of the postoperative interlid length with the other study variables listed earlier. A generalized linear model was used to determine the relation between the type of drain and the postoperative interlid length. RESULTS: Ninety-five patients (45 patients received a Penrose drain and 50 patients received suction drainage) were included for the study. The postoperative interlid length was unrelated to the other study variables (P > .05). The suction drain group had a significantly longer interlid length than the Penrose drain group at every postoperative interval (P < .05). CONCLUSION: The use of closed vacuum drainage in blowout fractures is more effective in the decrease of postoperative swelling than the use of a conventional Penrose drain.